Healthy Food & Healthy Living by Dr. Ayala

100% Whole Wheat Waffles

Waffles are one of our not-a-school-day treats. The aroma of baking waffles makes these weekend breakfasts feel like a special occasion – a lovely way to start the day. This recipe uses 100 percent whole wheat. I find that whole-wheat pastry flour, which is made of a soft mellow wheat, and is finely ground, makes amazing, delicate, light waffles – you won’t miss white flour at all.  The wheat germ adds another nutrition and flavor bonus.

One of the downsides of waffle making is that special equipment is needed. I apologize to my dear readers who don’t have access to a waffle iron. I’ll make it up to you with a recipe that needs nothing special next time.

Ingredients

• 2 cups whole-wheat pastry flour
• 2 tablespoons wheat germ
• 2 tablespoons sugar
• 2 teaspoons baking powder
• A pinch of salt
• 4 large eggs, separated
• 2 cups milk
• ½ stick (4 tablespoons) unsalted melted butter
• 1 teaspoon vanilla extract
• Butter for coating the waffle iron

Preparation

• Arrange 3 bowls
• In one bowl mix the dry ingredients: flour, wheat germ, sugar, baking powder and salt
• In second bowl whisk together the egg yolks and milk, and then whisk in the butter and the vanilla
• Whisk together the egg yolk mixture with the flour mixture
• In third bowl, beat the egg whites with an electric mixer until soft white peaks form
• With a rubber spatula, gently fold the egg whites into the waffle batter 

Now that your batter is ready, it’s time to warm up your waffle iron. (The batter will keep for a few hours in the fridge, but do take it out of the fridge for a few minutes before using it.)

Coat your waffle maker with a little bit of butter, and with a soup ladle pour enough batter to just cover the waffle grid – this batter rises mightily!

Follow the directions of your waffle iron – waffles usually bake in 2-3 minutes

Serve immediately with an assortment of berries and maple syrup.

Makes about 12 waffles.

Enjoy!

Dr. Ayala

 

Can olive oil and nuts prevent heart attacks?

A new study, just published online in the prestigious New England Journal of Medicine, was able to prove that diet – a tasty and rather easy to keep one at that – was able to reduce stroke and heart disease by 30 percent.

The study, led by Dr. Ramón Estruch from Barcelona, Spain, involved 7447 people, aged 55 to 80, all at higher risk for heart disease due to diabetes or at least 3 risk factors or heart disease, such as obesity, smoking, high blood pressure, elevated levels of bad cholesterol, or a family history of early heart disease.

Participants were randomly assigned to one of 3 groups:

• Mediterranean diet supplemented with approximately 4 cups a week of extra-virgin olive oil (OVOO);
• Mediterranean diet supplemented with an additional ounce daily of walnuts, hazelnuts and almonds;
• Control group that was counseled to eat a low-fat diet that did not include olive oil or nuts. This group received small nonfood gifts.

Both Mediterranean diet groups were encouraged to consume olive oil, nuts, fresh fruits and veggies (at least 5-a-day), legumes, white meat and wine in moderation with meals, and discouraged from soft drinks, commercial bakery goods such as pastries and sweets and red meat. Sofrito (a sauce made with tomatoes, onions, garlic and herbs, slowly simmered with olive oil) was also recommended – at least 2 servings a week. 

The control group was advised to eat low fat dairy, fruits and veggies (at least 5-a-day), lean fish and seafood, and discouraged from vegetable oils (including olive oil), commercial bakery goods, nuts, fried foods, red and processed fatty meat and fatty fish. 

To be fair, the study doesn’t really compare the Mediterranean diet to a low fat one, because the control group didn’t really adhere to a low-fat diet – they must have found it hard. So the comparison is really between a Mediterranean diet and a ‘whatever goes’ diet. 

Although people in all 3 groups had similar diets before the study started, compliance with the Mediterranean diet was good, and was verified not just by participants’ report, but also by measuring urinary hydroxytyrosol, a marker of olive oil intake, and blood alpha-linolenic acid, a marker of walnut consumption.

The participants were followed for the occurrence of heart attacks, strokes, and death from heart disease. After an average follow up of almost 5 years, 288 such events happened. Both Mediterranean diet groups experienced 30 percent less such events compared with the control group.

Quite encouraging! Especially since neither group was given a low calorie diet, or advised to lose weight – which could of course reduce heart disease and stroke risk, but isn’t easy to do. As a matter of fact the Mediterranean diet with OVOO group was encouraged to eat 4 tablespoons of the oil each day, which is 450 calories in OVOO alone! The Mediterranean diet with nuts group was supplied with about 200 calories-a-day in walnuts almonds and hazelnuts.

What’s special about this study?

The Mediterranean diet has shown its protective benefits against several diseases in many studies. A meta-analysis in the American Journal of Clinical Nutrition combined the findings of many prospective studies, pooling more than 2 million people, and showed that greater adherence to a Mediterranean diet – in line with pretty minor lifestyle changes, like eating a good amount of fruits and some nuts – was associated with 8 percent reduction in death, 10 percent reduction in cardiovascular illness and cardiac death, 6 percent reduction in cancer and 13 percent reduction in neurodegenerative diseases, such as Alzheimer’s, and to offer some protection from stroke and mild cognitive losses.

This study adds to previous evidence, and stands out due to its scientific rigor – it is a large, randomized controlled clinical trial, in which people were allocated by chance alone to eat in a certain way, were followed for a long time and were compared to a control group. Its results were also so conclusive that the trial was stopped early in order to report the results and allow the control group to enjoy the benefits of the Mediterranean treatment.

What’s the health-promoting ingredient in the Mediterranean diet?

So what should it be? Should we dip bread in olive oil twice a day or snack on almonds?

Let’s remember that this study tested the effects of a Mediterranean diet on heart disease and stroke. As much as we’d like to learn a magic trick from its findings, we cannot conclude that avoiding commercially baked goods, avoiding soda, eating sofrito, replacing red meat with fish or nibbling walnuts saves lives. The people in the study changed many eating habits during the study period.

The Mediterranean diet is an eating pattern, a total plan, and should adopted as one. We don’t know which part of the package confers the most benefit, all we know is that the pattern works as a whole; all parts of it are probably beneficial, and it very well might be that they work in combination with each other. The Mediterranean lifestyle – allowing for leisurely food enjoyment and social interaction – might be just as important.

I think the Mediterranean diet would be worth adopting for the sheer pleasure of it, and the health benefits are just another great reason to go Mediterranean.

But I’d stop short of the at-least-4-tablespoons-OVOO-daily the participants in this study were advised to eat. Way to many calories – leaves too little to play with if you’re also aiming for an energy balanced diet.

Dr. Ayala

 

How to pick a whole grain product

White bread is out, whole grains are in, and ‘whole grain’ is one of the hottest selling health claims. The USDA’s 2010 Dietary Guidelines recommend that at least half of daily grains be whole, and school lunch programs are required to serve half of the grains offered during the school week as whole ones.

Why whole grain?

Whole grain foods have a higher content of micronutrients, polyphenols, ‘good’ fats and fiber. They also have a lower glycemic index. Whole grain food consumption is associated lower risk of heart disease, weight gain and diabetes. Whole grains are also preferred for what they’re not: refined grains have lots of pure carbs – plain sugars, which supply energy, but little else.

But how do we define a whole grain food?

You’d be surprised to learn that there’s very little standardization of the whole grain declaration. In the US, a food product can use the official whole grain health claim if it contains at least 51 percent whole grain ingredients by wet weight. But not all genuine whole grain foods carry the official claim, and a food can qualify for the whole grain claim despite containing lots of added sugar and trans-fat – so whole grain junk food certainly exists. Foods can boast “made with” and “contains” whole grains without any specifics about the percentage of such grains.

So when you’re standing next to the cereal isle, what do you look for? The Whole Grain Stamp on the front of the package? Whole grain flour as the first ingredient? Did you bring your glasses and a calculator?

Navigating whole grains

A new study from the Harvard School of Public Health in Public Health Nutrition identified 545 grain products from the virtual shelves of Wal-Mart and Stop&Shop, looked at them through 5 different whole grain criteria, and evaluated which criteria better measures the healthfulness of the product.

The 5 ways whole grains were assessed were:

• The Whole Grain Stamp: the icon created by the Whole Grains Council can be displayed if the products have at least 8 g of whole grain per serving. Companies pay $1000 to $9000 in annual dues be part of this program
• Whole grain as the first ingredient on the ingredient list
• Whole grain as first ingredient and no added sugars in the product
• The word ‘whole’ before any grain anywhere in the ingredient list
• A ratio of 10:1 or less of total carbohydrate to fiber: This is The American Heart Association’s strategy. 10:1 is approximately the ratio of carbohydrate to fiber in whole-wheat flour.

Useful criteria would be practical, identify foods that are healthier, and find enough of them to give customers (and schools) plenty of options to choose from.

The best guideline according to the authors, led by Rebecca Mozaffarian, was the 10:1 ratio. This method asks for a little bit of work: divide the total carbs by the total fiber on the nutrition label, for instance, one serving of Cheerios has 22 grams of carbs, and 3 grams of fiber, and without doing the exact calculation it’s clear that the ratio is less than 10:1 (it’s about 7), which puts this cereal in the satisfactory list. The 10:1 identifies foods with more fiber and less sugars (the neat point about this method is that if there were lots of added sugar it would add to the total carbs, changing the score for the worse).

One obvious loophole in this approach is that manufacturers can easily add bran to the product, upping the fiber content, and reaching a lower than 10:1. (Sugar-water with vitamins isn’t the same as fruit, and refined grain products with added fiber just aren’t whole grain – our body does know the difference.)

The industry supported Whole Grain Stamp helped identify products with more fiber, but many of them also had more sugar, and a higher caloric count, and many whole grain products don’t carry the stamp.

Whole grain as the first ingredient, which I think is quite popular among health conscious consumers, and ‘whole-anywhere’, were much less restrictive, and qualified more products, but they, too, failed to weed out foods with more sugar and more calories.

Whole grain as first ingredient and no added sugars was quite restrictive, and qualified only 17 percent of the tested products. Another downside is that this method requires a very careful read of the ingredient list – added sugars hide under many guises such as brown rice syrup and fruit juice concentrate, and our food label doesn’t give us any idea about how much sugar was added.

The take home message

This article will definitely make me look further into the 10:1 ratio, which, frankly, I’d never thought of before.

And it definitely sheds new light on the industry-supported Whole Grain Stamp. The symbol signifies the presence of significant amounts of whole grains, but consumers should know it looks at no other ingredients and factors affecting healthfulness.

No matter which guideline -- or combination of guidelines -- you use, you need to read the ingredient list, because as this study reemphasizes, the words ‘whole grain’ don’t necessarily mean this food’s wholesome, and in case you’re using the 10:1 ratio, make sure the product didn’t get there by adding fiber. Clearly, consumers could benefit from a clever food label makeover that can better assist them in whole grain product selection.

One of the best ways to eat whole grains is to make them yourself, and while I’m not suggesting you start baking your daily loaf from wheat you grew in your back yard, cooking brown rice, oatmeal (oatmeal is always whole grain), quinoa and wheat berries is practical, inexpensive and 100 percent whole grain!

Dr. Ayala